Centers for Disease Control and Prevention
We are providing this update to help inform Congress and congressional staff about the current status of 2009 H1N1 Influenza and related topics. This update will be issued on Fridays unless events dictate otherwise. HHSâ Assistant Secretary for Legislation will also be hosting periodic telebriefings on 2009 H1N1. Questions should be directed to CDC/Washington at 202-245-0600.
Note: Green text indicates new information. Black text indicates background and other information also included in previous updates.
October 30, 2009 (Fall 2009; Issue 5)
In This Email (in Outlook and on some Blackberry devices, you can click on these headings and express to these sections):
- Secretary Sebelius Authorizes Release of Remaining Pediatric Tamiflu from Strategic National Stockpile
- Current 2009 H1N1 Situation Update
- General Seasonal Influenza Updates
- 2009 H1N1 Vaccine Information
- Protecting Healthcare Workers
- Emergency Use Authorization for Peramivir
- Presidential Declaration and the Stafford Act
- CDC Guidance on Prevention and Control
- Communication Tools for Members and Constituents
- Media Updates
Secretary Sebelius Authorizes Release of Remaining Pediatric Tamiflu from Strategic National Stockpile
On Thursday, October 29, Secretary Sebelius authorized the release of the remaining bottles of oseltamivir pediatric suspension (Tamiflu)âapproximately 234,000 bottlesâfrom the strategic national stockpile (SNS). SNS is currently contacting project areas to determine if they would like to receive their pro rata share of the antiviral and states began placing orders on October 30. Shipments of the pediatric antiviral will begin on Monday, November 2.
Current 2009 H1N1 Situation Update
In the U.S. from August 30 â October 24, 2009, 12,466 laboratory confirmed influenza associated hospitalizations, 530 laboratory-confirmed influenza associated deaths, 25,985 pneumonia and influenza syndrome-based hospitalizations, and 2,916 pneumonia and influenza syndrome-based deaths, were reported to CDC.
A total of 114 deaths in children associated with 2009 H1N1 virus have been reported to CDC.
Currently, flu activity is increasing in most of the United States with 48 states reporting widespread influenza activity. See map below for updated view of influenza in the U.S.
More information regarding 2009 H1N1 Influenza activity can be viewed here.
More information about CDC′s 2009 H1N1 influenza surveillance system is available here.
Weekly updates on the global 2009 H1N1 Influenza situation can be found here.
General Seasonal Influenza Updates
- Individuals should be encouraged to seek seasonal flu vaccine.
- There are many millions of doses yet to be distributed this season. As distribution continues, however, some individuals may have to obtain the vaccine from a source other than their preferred provider.
- As of October 23, 89 million doses, or 77 percent of the total seasonal influenza vaccine doses expected this season have been distributed in the private and public sectors.
- It is estimated that the total number of doses that will be manufactured this year is approximately the same as the number of doses that were actually administered last season. Manufacturers now estimate that a total of 114 million doses will be brought to the U.S. market.
- People can find seasonal vaccine by checking the American Lung Association web site that identifies clinics that have influenza vaccine available: http://www.flucliniclocator.org/
- We are still early in flu season; there is still time for people to get vaccinated to protect themselves from becoming ill.
- Many more individuals have been vaccinated against seasonal influenza this season than at the same time last year. This is most likely due to the early availability of vaccine.
2009 H1N1 Vaccination Information
Vaccine Production and Distribution
All states and the District of Columbia have placed orders for vaccine. As of October 30 (Friday), a total of26,686,400doses were available for ordering. Of those available doses, 17,920,600 doses were injectable and 8,765,800 were nasal spray vaccine. As ofOctober 28 (Wednesday),16,870,000 doses had shipped.
Since September 30, when the 2009 H1N1 vaccine was first made available to states to order, the number of doses that has been produced, distributed, and administered has grown steadily, and states are executing their plans for providing vaccine to high-priority populations. While modest amounts of vaccine have been made available ahead of schedule, a series of manufacturing delays has caused significant reductions in the manufacturers′ projected vaccine output and the number of doses delivered so far. Most reasons for these delays have now been overcome, and production of the vaccine components is proceeding as expected but on a revised schedule. HHS is working closely with the vaccine manufacturers to get the vaccine supplies flowing to the public as vaccine becomes available. Although we had hoped to have more vaccine distributed by this point, ultimately everyone who wants to receive the vaccine will be able to get vaccinated. These current delays will not alter the per capita allotment basis for states, nor will it affect the method through which states are able to order and receive their allocated doses. CDC is working closely with states to ensure that vaccine gets to the public as soon as we receive it, and CDC has worked with its distributors to ensure round-the-clock shipping capabilities and 24 hour turn-around time on distribution. CDC continues to offer technical assistance to, and meets regularly with, states and other partners to improve the effectiveness of the vaccination program. Weekly updates on 2009 H1N1 vaccine allocated, ordered, and shipped are available here.
See questions and answers about 2009 H1N1 Influenza vaccine distribution here.
To find out where 2009 H1N1 or seasonal flu vaccine is available near you, access the flu.gov vaccine locator here.
Vaccine Recommendations
- Inactivated vaccines against both the seasonal and 2009 H1N1 influenza viruses can be received on the same day. Live 2009 H1N1 vaccine can be administered at the same visit as any other live or inactivated vaccine except seasonal live attenuated influenza vaccine. The seasonal vaccine is already available in many locations, however, and individuals are encouraged to get their seasonal flu vaccine as soon as possible.
- For individuals needing more than one dose of the 2009 H1N1 vaccine, CDC recommends that the two doses be separated by approximately four weeks. If the second dose is separated from the first dose by at least 21 days, however, the second dose can be considered valid.
- Vaccine will become increasingly available in a combination of settings such as vaccination clinics organized by local health departments, healthcare provider offices, schools, and other private settings, such as pharmacies and workplaces.
Vaccine Safety
- Neither the 2009 H1N1 influenza vaccine nor the 2009-2010 seasonal influenza vaccine have been associated with any unexpected adverse events.
- The CDC and FDA closely monitor the safety of seasonal influenza and other vaccines licensed for use in the United States in cooperation with state and local health departments, healthcare providers, and other partners.
- Clinical trials on 2009 H1N1 influenza vaccine began in July and are ongoing. Information from the trials indicates the vaccines are safe, and that one dose of vaccine provides protection to most healthy adults and children 10-17 years old. Children younger than 10 years should receive two doses of 2009 H1N1 flu vaccine. The trials are also seeking information on pregnant women and on immune-compromised individuals.
- CDC and its partners are using several systems to monitor the safety of 2009 H1N1 monovalent influenza vaccine. Two primary systems are the Vaccine Adverse Event Reporting System (VAERS), which is jointly operated with FDA, and the Vaccine Safety Datalink (VSD) Project.
Read more about 2009 H1N1 Influenza vaccine safety here.
Protecting Healthcare Workers
On Wednesday, October 14, CDC released updated interim guidance on infection control measures to prevent transmission of the 2009 H1N1 influenza virus in healthcare facilities and protect healthcare workers against the virus. The guidance recommends a comprehensive approach using a hierarchy of controls, including in order of importance: (1) eliminating potential exposures (e.g., taking steps to minimize outpatient visits by patients with mild influenza-like illness), (2) engineering controls (e.g., installing partitions in triage areas), (3) administrative controls (e.g., promoting and providing vaccination and enforcing exclusion of ill healthcare workers), and (4) personal protective equipment (e.g., respirators). CDC's guidance continues to recommend the use of respiratory protection at least as protective as N95 respirators for healthcare personnel who are in close contact with patients with suspected or confirmed 2009 H1N1 influenza. If a healthcare facility experiences a shortage of respirators, the guidance recommends that the facility prioritize the use of respirators for healthcare workers at the greatest risk of exposure and with risk factors for influenza-related complications and that other healthcare personnel wear facemasks instead.
Currently, some healthcare facilities are experiencing shortages of respiratory protective equipment, including N95 respirators. As of October 2009, the current U.S. production of N95 respirators for industrial and healthcare use is 125 million per month. According to manufacturers, production is not adequate to meet demand.
The Strategic National Stockpile (SNS) contains a supply of N95 respirators, intended to be distributed to states, territories, and major cities as needed in a pandemic influenza response. In spring 2009, the SNS released 25 million N95 respirators. On October 19, 2009, an additional 59.5 million N95 respirators (about 75 percent of the remaining inventory) were deployed to the areas that chose to receive them at this time. To date, 60 of the 62 âproject areasâ (the 50 states, plus territories and major cities) have requested respirators; and as of October 28, 2009 this deployment is approximately 50% complete and on schedule. Approximately 20 million N95 respirators will remain in the stockpile.
Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel can be viewed here.
Questions and Answers Regarding Respiratory Protection for Infection Control Measures for 2009 H1N1 Influenza among Healthcare Personnel are available here.
Emergency Use Authorization for Peramivir
On Friday, October 23, the FDA issued an emergency use authorization (EUA) for the investigational antiviral drug peramivir intravenous (IV) in certain patients with confirmed or suspected 2009 H1N1 influenza infection. An EUA may be issued by the FDA to allow either the use of an unapproved medical product or an unapproved use of an approved medical product during certain types of emergencies. The EUA is intended to expand antiviral treatment options for hospitalized patients unable to use currently available FDA-approved agents that are taken orally or inhaled.
More information on the EUA and peramivir is available here. Questions and Answers about peramivir for health care providers are available here.
Presidential Declaration and the Stafford Act
On October 24, 2009, President Obama signed a proclamation declaring the 2009 H1N1 influenza pandemic a National Emergency. This proclamation will facilitate the response to the pandemic by enabling â if warranted on a case-by-case basis â the waiver of certain Federal requirements for medical facilities responding to the surge of patients with the 2009 H1N1 virus. Examples of such waivers include allowing hospitals to set up an alternative screening location for patients away from the hospital′s main campus and allowing skilled nursing facilities to increase the number of certified beds.
A Presidential proclamation of a national emergency under the National Emergencies Act and a Presidential declaration of an emergency or major disaster under the Stafford Act are distinct and separate declarations. The President′s proclamation does not trigger a Stafford Act declaration or provide financial or other resources.
In general, when an incident overwhelms or is anticipated to overwhelm State resources, the Governor may request Federal assistance, including assistance under the Stafford Act. The Stafford Act authorizes the President to provide financial and other assistance to State and local governments, certain private nonprofit organizations, and individuals to support response, recovery, and mitigation efforts following Presidential emergency or major disaster declarations.
More information on the Stafford Act and pandemic influenza is available here.
CDC Guidance on Prevention and Control
CDC has issued (or updated) guidance to help individuals, schools, businesses, and others take steps to avoid the flu and deal with its consequences. All guidance can be accessed at
http://www.cdc.gov/h1n1flu/guidance/. Below, we have provided direct links to key guidance that may be of interest.
Guidance for Child care Programs, Schools, Colleges and Universities
Guidance for Institutions of Higher Learning
Guidance for Childcare Facilities
Business and Employer Guidance
Guidance for Business, Employers and Workplaces
Communication Toolkit for the Federal Workforce
Guidance for State, Local, Tribal and Territorial Health Officials
Vaccination Guidance for State, Local, Tribal and Territorial Health Officials
Healthcare Providers and Facilities: Decision Tree for 2009 H1N1 Vaccination
Clinician Guidance
Clinician Guidance Regarding Diagnostic Tests
>Guidance for the use of Antiviral Medications
Guidance for Clinicians Regarding Patients with Asthma
2009 H1N1 Flu and Seasonal Flu Information for Rheumatology Health Professionals
Infection Control
Guidance for Individuals Handling 2009 H1N1 Clinical Specimens or Isolates
Interim Guidance on Infection Control Measures for 2009 H1N1 Influenza in Healthcare Settings, Including Protection of Healthcare Personnel
Guidance for Patients and Caretakers
Guidance for Patients and Caretakers (and here)
Emergency Personnel Guidance
Implementation Guidance for Managing Calls and Call Centers during a Large-Scale Influenza Outbreak
Guidance for Community Settings
Guidance for Community Settings
Travel and Travel Industry Guidance
Guidance for Travel and Travel Industry: Cruise Ships
Guidance for Travel and Travel Industry: Airlines
Epidemiology and Surveillance
Interim Guidance for Influenza Surveillance: Prioritizing RT-PCR Testing in Laboratories
Communication Tools for Members and Constituents
CDC recognizes that H1N1 flu is of significant interest and concern to your constituents. With this in mind, we offer cutting edge CDC communication tools you can use to effectively communicate information about 2009 H1N1 flu during the upcoming flu season:
- Short (less than 140 characters) messages that you or your member can post to their Twitter account provide effective messages and shortened links to further information on H1N1
- CDC and Flu.gov Twitter feeds (@CDCemergency, @CDCFlu, @CDC_ehealth, and @FluGov) that provide regularly updated information (and can be âre-tweetedâ by members that use Twitter to disseminate information to constituents)
- Buttons (in both English and Spanish), widgets, e-cards, and other tools that can be used on websites or in email newsletters
- CDC′s image library, containing H1N1 flu-related images that can be used in your web materials and newsletters
- CDC′s dedicated Youtube channel and other videos containing H1N1 and other health information
- Podcasts of H1N1 and other health information, featuring CDC experts
All of these resources can be found at http://www.cdc.gov/SocialMedia/Campaigns/H1N1/. If you need technical assistance in using these tools, please contact Justin Cormier (jcormier@cdc.gov) or Andi Lipstein (alipstein@cdc.gov) in the CDC Washington Office.
Additionally, the U.S. Department of Health and Human Services (HHS) announced the availability of thirteen new 30-second flu radio public service announcements (PSA) this week. These new radio messages feature 13 of America's governors and Elmo from Sesame Street. The messages, which will be distributed to radio stations across the country, promote key flu prevention messages to parents and children. All of the new ads are available for download.
We also have produced a variety of materials that can be printed at a local (or commercial) printer and distributed. We do not stock these documents, but they can be useful handouts at district events. You can access these resources here.
Media Updates
CDC conducts regular media updates and briefings regarding 2009 H1N1 Influenza. Transcripts of these briefings, as well as audio recordings, are available here.
- Historical Document: November 2, 2009
- Content source: CDC Washington
Content Management: Office of Enterprise Communication - Notice: Linking to a non-federal site does not constitute an endorsement by HHS, CDC or any of its employees of the sponsors or the information and products presented on the site.
